Tunisian health profile: present state and trends

We will try to value the Tunisian Health Profile, its present state and its tendencies. Data have been collected by various sources, in particular international and national organism. The total fertility rate passed from 8 in 1966 to 2.01 in 1999. Besides a light ageing of the population is started (9% of the population are aged of more than 60 years in 1999). Death rates recorded a decrease, mainly of the infantile mortality (140%@1000 in 1966 against 24.7%@1000 in 1999) and the maternal mortality (68.9 per 100,000 living births in 1994 against 220 in 1980-1984). The life expectancy at birth passed from 51 years in 1966 to 72.4 years in 1999. According the morbidity we attend the receding of the majority of transmitted diseases. Resources injected in the system of cares also evolved: The medical density passed from 1 per 6700 inhabitants in 1966 to 1 per 1300 in 1999. Tunisia recorded the most elevated scores for the preventive activities in particular at the vaccinal coverage. The global evolution of the Tunisian health profile is marked by the epidemiological transition buy which pass the country currently. This phase is delicate because it's generating of a growth of care expenses. Decision-makers must be careful to consider advantage priorities and the profitability of the investments.     

Loss of the cell cycle inhibitors p21(Cip1) and p27(Kip1) enhances tumorigenesis in knockout mouse models

Events that contribute to tumor formation include mutations in the ras gene and loss or inactivation of cell cycle inhibitors such as p21(Cip1) and p27(Kip1). In our previous publication, we showed that mice expressing the MMTV/v-Ha-ras transgene developed tumors earlier and at higher multiplicities in the absence than in the presence of p21(Cip1). To further evaluate the combinatorial role of genetic alterations and loss of cell cycle inhibitors in tumorigenesis, we performed two companion studies. In the first study, wild type and p21(Cip1)-null mice were exposed to the chemical carcinogen, urethane. Similar to its effects in v-Ha-ras mice, loss of p21(Cip1) accelerated tumor onset and increased tumor multiplicity in urethane-treated mice. Lung tumors were the predominant tumor type in urethane-treated mice regardless of p21(Cip1) status. In the second study, tumor formation was monitored in v-Ha-ras mice expressing or lacking p27(Kip1). Unlike p21(Cip1), the absence of p27(Kip1) had no effect on the timing or multiplicity of tumor formation, which was largely restricted to mammary and salivary glands. However, once tumors appeared, they grew faster in p27(Kip1)-null mice than in p27(Kip1)-wild type mice. Increases in growth rate were particularly striking for salivary tumors in ras/p27(-/-) mice. Loss of p21(Cip1), on the other hand, had no effect on tumor growth rate in v-Ha-ras mice. Collectively, our data suggest that p21(Cip1) suppresses tumor formation elicited by multiple agents and that p21(Cip1) and p27(Kip1) suppress tumor formation in different ways.     

Obesity in children

The aim of this prospective study is to evaluate the frequency of the obesity in the population of 951 children aged between 6 and 12 years old, scholarized in two primary schools situate in Ariana. We found 50 obese children between them (5.25%). The weight and the height of these children were more than 3 standards deviations compared to the normal. 66% of these children have one or two obese parents and 74% were the oldest or the youngest child in the family. The food intake was more important than the normal and it was hyperglucidic rich in sugar and hyperprotidic with troubles of dietetic comportment.     

Incidence of surgical wound infections a prospective study in the Rabat Mohamed-V military hospital, Morocco

OBJECTIVES: The authors had for aim to determine prospectively the incidence of surgical site infections (SSI) in a visceral surgery department, in the Mohamed V military hospital (Rabat), and to identify risk factors. PATIENTS AND METHODS: All patients who had undergone surgery between April 1 and September 30, 2002 and were then admitted in the visceral surgery unit were included in this study. Patients were assessed within the following month. For each patient, data including perioperative factors, type of procedure, and SSI occurrence were collected on a standardized form. RESULTS: During the study, 310 patients were operated. The number of surgical wound infections was 16 (5.2%). This analysis pointed out: 11 superficial wounds, 5 deep wounds, and 1 organ/site wound. Emergency, age, ASA score, Altemeier classification, and procedure duration were found to be risk factors for SSI in visceral surgery. According to the NNIS index, SSI rates increase from 2.7% for patients with a risk index of 0 to 10.2% for patients with a risk index of 3. CONCLUSION: The high incidence of SSI emphasizes the importance of implementing SSI surveillance in surgery to obtain standardized incidence ratios necessary for adapted control measures.     

Prevention of central venous line-related thrombosis by continuous infusion of low-dose unfractionated heparin, in patients with haemato-oncological disease. A randomized controlled trial

We have conducted a prospective randomized controlled trial to evaluate the role of low-dose unfractionated heparin prophylaxis in preventing central venous line-related thrombosis in patients with haemato-oncological disease. Patients were randomly assigned to receive either prophylactic intravenous unfractionated heparin (continuous infusion of 100 IU/kg/daily) or 50 ml/daily of normal saline solution as a continuous infusion. CVLs were externalized, non tunneled, double lumen catheters. All CVLs were placed percutaneously by the same physician in the subclavian vein. Upper limb veins were systematically examined by ultrasonography just before, or <24 hours after, catheter removal, and in case of clinical signs of thrombosis. One hundred and twenty-eight CVLs were inserted. Catheter-related thrombosis occurred in 1.5% of the catheters inserted in patients of the heparin group, and in 12.6% in the control group (p = 0.03). No other risk factors were found for the development of catheter-related thrombosis. Two and three patients experienced severe bleeding in the heparin group, and in the control group, respectively (p = 0.18). There were no other side-effects clearly ascribable to the use of unfractionated heparin. This is the first prospective, randomized study, which shows that low-dose of unfractionated heparin is safe and effective to prevent catheter-related thrombosis in patients with haemato-oncological disease.     

Male gonococcal urethritis in the region of Sfax (1996-2000)

The sexually transmitted infections pose a real public health problem, mainly in developing countries. In Tunisia, the epidemiological state is not precise. The objective of our study was to determine the sociological, epidemiological and bacteriological characteristics of gonococcal urethritis in the area of Sfax. The study was performed on all patients attending at the CNSS of Sfax for urethritis for 5 years, from 1996 to 2000. A urethral swab was carried out for each patient with a classic bacteriological exam. 256 cases were collected. The mean age was 29.7 years. 74.3% were workers. The direct exam was positive in 51.2% of cases and the culture enabled us to isolate 72 strains, of which 15.5% were productive of beta-lactamase and 23.9% were resistant to tetracyclin. There was no resistance to pristinamycin, ofloxacin nor spectinomycin.     

Attitude to cervical cancer screening of women residing in two regions of northern Tunisia

The objective of this survey to describe knowledge, attitudes and behaviours of women residing in two regions of the North of Tunisia, towards cervical cancer screening methods. 936 women residing to the Ariana (urbanized region) and 993 women residing to Zaghouan (region to farming predominance) were included; they were chosen according to the method of quotas while taking like criteria's, the of area residence (urban or rural), age and the level of education. Every woman should have answered to a questionnaire. Data collected were related to women perception of the severity of the cervical cancer, of their vulnerability for this cancer, of screening efficiency and the recourse of women to this service. The recourse to the cervical cancer screening was significantly more frequent in Ariana (24,6% vs. 13,8% p <0,001); the half of women is optimistic towards the therapeutic progress recorded in Tunisia in the domain of cancer. A better organization of cervical cancer screening including the individual invitations of women and a better sensitization and implication of physicians of the first line in the two sectors public and private, are indispensable to improve the frequency of recourse to cervical cancer screening.